38 - Implementation of an Explicit Clinical Reasoning (CR) Curriculum in an Anatomy Course for Doctor of Physical Therapy (DPT) Students

Poster Board Number: 38
There are separate poster presentation times for odd and even posters.
Odd poster #s – first hour
Even poster #s – second hour

Abstract Body : Introduction
Clinical reasoning (CR) is complex and prone to errors, yet a foundational skill for health professionals. Effective strategies to mitigate errors in CR include using a systematic approach, developing pattern recognition skills, generating multiple hypotheses, and applying metacognitive strategies to make thinking visible. Foundational sciences, such as anatomy, can be used to establish a systematic approach for effective CR development. However, educators are challenged to teach and assess CR without a framework. The purpose of this abstract is to describe the explicit pedagogical approach used to develop CR skills in first-year, anatomy courses in a Doctor of Physical Therapy (DPT) curriculum and how it is then threaded through future courses.

Methods
The Hypothesis Oriented Orthopedic-Focused Algorithm (HOO-FA) is a CR tool designed to guide students and novice clinicians through the CR process. The HOO-FA was created using two previously published algorithms, the HOAC II and the SCRIPT. The tool is a 7-step process that helps make thinking visible.

The initial step in the HOO-FA tool is grounded in anatomy and helps formulate preliminary diagnostic hypotheses based on the patient’s symptom map. Diagnostic reasoning is facilitated by listing relevant anatomical structures under the area of symptoms and those that refer pain into the area. The subsequent 6 steps of the HOO-FA explore reasoning related to additional aspects of the exam, evaluation, and plan of care.

Results
The HOO-FA is used in multiple courses in the DPT program to provide a systematic framework to develop CR skills. The tool is introduced in 2 anatomy courses in the first semester and later in 4 musculoskeletal courses. These 6 courses account for 20 of the 99 credits (20%) of the program.

Step 1 of the HOO-FA is the focus of the 2 anatomy courses. Assignments using the HOO-FA allow students to utilize their knowledge of anatomy to generate multiple hypotheses based on a symptom map and apply metacognitive strategies to make thinking visible. In the subsequent musculoskeletal courses, all 7 steps of the HOO-FA tool are utilized. CR skills are assessed for all 6 courses using the HOO-FA during lab immersions, which simulate clinical practice.

Conclusion
Effective strategies to lessen errors in CR can be taught and assessed in human anatomy courses. The HOO-FA can help faculty implement a framework to explicitly develop CR skills in anatomy courses that can be threaded throughout a curriculum to help students move from novice to more proficient CR skills. This is the first known description of an intentional CR tool such as the HOO-FA being implemented in a first-year anatomy course and threaded through a DPT program.

Significance
Despite the need to improve the teaching and assessment of CR in health professions education, explicit, theory-informed CR curricula and assessment tools are lacking. Threading the HOO-FA in a DPT program helps learners understand where they are prone to errors in CR by making their thinking visible, generating multiple hypotheses, and developing pattern recognition skills. Moreover, implementing a CR framework early on in foundational science courses, such as anatomy, helps students develop the reasoning skills essential for applied science and clinical management courses. Future research should establish the reliability, validity, and feasibility of the HOO-FA in health care education to ensure competency in CR is being achieved.